Differential Diagnosis
The patient's symptoms of runny nose, cough, fussiness, bilateral wheezes, and crackles, along with a history of exposure to ill children in day care, suggest a respiratory infection. The differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- Bronchiolitis: This is the most likely diagnosis given the patient's age, symptoms, and exposure history. Bronchiolitis is a common respiratory illness in infants, often caused by respiratory syncytial virus (RSV), and is characterized by inflammation of the small airways.
- Other Likely diagnoses
- Viral pneumonia: The patient's symptoms and physical examination findings, such as bilateral wheezes and crackles, could also be consistent with viral pneumonia.
- Influenza: Although less common in this age group, influenza should be considered, especially during the winter season.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Apnea: The patient is at risk of developing apnea, especially if the underlying condition is bronchiolitis or another respiratory infection. Apnea can be a life-threatening complication, particularly in young infants.
- Bacteremia: Although less likely, bacteremia should be considered, especially if the patient's condition worsens or if there are signs of sepsis.
- Rare diagnoses
- Congenital heart disease: Although the patient's birth history is unremarkable, congenital heart disease could present with similar symptoms, such as fussiness and respiratory distress.
- Cystic fibrosis: This is a rare genetic disorder that can present with respiratory symptoms, but it is less likely given the patient's age and lack of other symptoms.
The patient is at greatest risk of developing apnea as a complication, given the symptoms and age of the patient. Apnea is a well-known complication of bronchiolitis and other respiratory infections in young infants, and it requires close monitoring and prompt intervention if it occurs.